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Ask The Doctor: When (And How) To Offer Help To Someone With Depression

If you suspect that someone you care about is experiencing depression, here are answers on the signs to look for and what you should say.

by Raymond DePaulo, Jr., MD

How can I tell when someone needs help for depression?

It can be extremely concerning when someone’s mood and behavior changes for the worse, or when they appear disinterested in their own well-being.

For example, you may notice mood is unusually down or sad, or emotional responses are way too irritable or apathetic. The friend or family member is physically fatigued for no good reason, or more inattentive or forgetful than usual.

You may become aware that performance at work or school has dropped off, or things around the house aren’t getting done. You may also notice increasing social isolation, such as declining invitations from friends. Neglect of grooming habits should raise red flags, along with losing interest in things the person has always liked.

Anyone might have a down day, feel especially tired, or not want to socialize now and then. When the symptoms you observe have lingered for more than two weeks, it’s reasonable to express your concern. (If the person’s health or life seem at risk, however, you should act immediately.)

In all of medicine, assessment and diagnosis come before treatment. Encourage your friend or family member to get an evaluation by a qualified health professional, be it the person’s primary care doctor or nurse practitioner or someone in the mental health field.

How can I persuade the person to go see a professional?

Your first step should be to briefly share what you’ve observed about the person’s mood, energy level, and behaviors. Explain why you’re concerned and that you want to help.

However, what’s obvious to you may not be so clear to the person in question—at least, not at first. Be prepared for multiple conversations in the weeks and even months ahead.

If the person initially dismisses your concerns, you might ask, “Do you agree that there is a change in you?” Don’t argue—just try to find out as much as you can about why they feel they don’t need help. Some common roadblocks:

UNWILLINGNESS TO ACCEPT HELP. Typical responses range from, “I can beat this on my own,” to, “If I can’t fix this, then no one else can, either,” especially if the person believes depression is a moral failure rather than a medical condition.

DISLIKE OR DISTRUST OF TREATMENTS for depression. Remind the person that a consultation is not a commitment to be treated. It can’t hurt to find out what, if anything, is wrong, and what treatment, if any, might be recommended.

LACK OF WILL: Sometimes the person is aware that something is wrong, but has lost the energy or motivation to do anything about it. Offer to make the appointment for evaluation and get the person there.

It’s good to come to your conversations armed with information about the experience of depression from books, online resources, and other people who have had depression.

It’s also useful to gather observations from others who care about the loved one you are worried about. You want as much support as you can find for these discussions.

Remember that effective treatment in the long run requires the individual to become an active partner in care. Waiting until your loved one agrees that seeking help is a good thing can be a wise investment of time.

What if the situation can’t wait?

If your loved one says things like, “I can’t go on living like this,” or otherwise shows that they would consider ending their life, be clear and direct with your words, deeds and emotions: “We can’t lose you. We love you. We need to go get help now.”

If you sense that your loved one feels suicidal, ask directly, “Are you thinking of hurting yourself?” If the person denies it but you still have strong suspicions, make it clear that they need to come with you and get the opinion of a respected clinician. If other family members agree, you can intervene as a team.

If the situation is urgent, consult your local suicide helpline for advice and resources. As a last resort, consider calling the police to get an emergency evaluation.

J. Raymond DePaulo, Jr., MD, is co-director of the Mood Disorders Center at Johns Hopkins University School of Medicine and is a University Distinguished Service Professor in the psychiatry and behavioral sciences department. He is current chair of the National Network of Depression Centers, based in Ann Arbor, Michigan, and has written two books for a popular audience, Understanding Depression and How to Cope with Depression.

3 COMMENTS

Minister of Joy

Our denomination, the Christian Church (Disciples of Christ) in the United States and Canada is focusing on the stigma of mental health issues such as depression and anxiety. The group is named the Affinity Group. My life has been difficult until I seriously studied happiness and the emotion joy. Several years ago, I wrote “Dancing With Bipolar Bears: Living in Joy . Despite Illness.” This year I published “Dancing With God: A Theology of Joy.” A colleague on the Affinity Group, Sarah Lund wrote “Blessed Are the Crazy.”

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HEALTHY HABITS

Most of us don’t default to healthy habits. It takes planning and effort, and sometimes a surge of self-discipline, to eat right, exercise, get the sleep we need, and stay on top of work and life tasks. Establishing new habits, let alone purging bad ones, can require major effort, especially if we are also struggling with depression or anxiety. What are some good habits that you've formed and how did you build them?